"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

March 19, 2015

The Centre for Health Protection (CHP) of the Department of Health today (March 19) reported the latest surveillance data of the winter influenza season, and again urged the public to heighten vigilance and get vaccinated early against seasonal influenza.

Regarding severe cases, from noon yesterday (March 18) to noon today, five additional cases of influenza-associated admission to intensive care units or death (including three deaths) among adults aged 18 or above had been recorded under the enhanced surveillance in collaboration with public and private hospitals reactivated since January 2. Two additional deaths were recorded among previously reported cases, bringing the total to 534 (404 deaths) so far. Among them, 505 were A(H3N2), seven were A(H1N1)pdm09, seven were A pending subtype and 15 were B. In the last winter season in early 2014, 266 cases (133 deaths) were filed.

Last week (from March 8 to 14), 36 cases (29 deaths) were recorded. Separately, a daily average of 5.7 cases (4.4 deaths) were filed in the last seven days (from March 12 to 18), compared with 6.7 cases (5.3 deaths) in the preceding seven days (from March 5 to 11).

Meanwhile, no additional cases of severe paediatric influenza-associated complications or death among children aged under 18 have been reported since yesterday via the ongoing reporting system. The total this year remains 18 (one death) and all were A(H3N2). In 2014, 27 cases (four deaths) were filed.

March 11, 2015

From noon yesterday (March 10) to noon today, two additional cases of influenza-associated admission to intensive care units or death (including two deaths) among adults aged 18 or above had been recorded under the enhanced surveillance in collaboration with public and private hospitals reactivated since January 2, bringing the total to 482 (361 deaths) so far. Among them, 459 were A(H3N2), five were A(H1N1)pdm09, seven were A pending subtype and 11 were B. In the last winter season in early 2014, 266 cases (133 deaths) were filed.

Last week (from March 1 to 7), 57 cases (44 deaths) were recorded. Separately, a daily average of 6.1 cases (5.1 deaths) were filed in the last seven days (from March 4 to 10), compared with 8.1 cases (5.7 deaths) in the preceding seven days (from February 25 to March 3).

Meanwhile, an additional case of severe paediatric influenza-associated complication or death among children aged under 18 has been reported since yesterday via the ongoing reporting system, bringing the total this year to 18 (one death) and all were A(H3N2). In 2014, 27 cases (four deaths) were filed.

The weekly number decreased from 26 (affecting 121 persons) in the last week of February to 11 (55 persons) last week when most schools resumed after the Lunar New Year. As of yesterday, seven (36 persons) had been recorded so far this week. Outbreaks in the past four weeks mainly occurred in residential care homes for the elderly (66.0 per cent).

March 09, 2015

MUMBAI: The number of H1N1 cases in the city breached the 800 mark on Sunday, taking it statistically close to the 2010 situation when a global swine flu pandemic was raging on. That year, Mumbai reported 847 confirmed cases and 30 deaths.

While in terms of fatalities the city is better placed with seven deaths this time, it has already reported 802 confirmed cases, that too within two months and a week since the start of the year.

In addition, another 13 deaths and 121 cases have been attributed to people who came to the city for treatment. Experts are wary of equating the severity of the situation with the 2009-10 phase, though they agree that this is one of the most aggressive H1N1 bouts since then.

Officially, the virus has claimed 1,319 lives and affected over 25,000 all over the country since the beginning of this year. Incidentally, the number of reported cases in 2010 was 20,604, while the number of deaths was 1,763. At the state level, deaths have been mounting, with another ten lives lost in the last 48 hours. The cumulative toll has gone up to 221 since January 1. Besides, a total of 115 people tested positive for swine flu on Sunday, taking the number of cases to 2,501 in Maharashtra.

Former director of Pune's National Institute of Virology (NIV) Dr AC Mishra blamed the virus's increased circulation on seasonal fluctuation rather than any change in the virus itself. Also, he said it may be unfair to compare the current epidemic to that of the pandemic period.

"What started in 2009 and went on till mid-2010 was a global pandemic. We were fighting a new virus with limited testing facilities. Things are different now," he said.

"We could be reporting more cases simply because every state in the country is equipped with better labs. This time it is more about erratic weather, unlike 2010 when people had no immunity against the virus."

March 08, 2015

The Centre for Health Protection (CHP) of the Department of Health today (March 8) reported the latest surveillance data of the winter influenza season, and again urged the public to heighten vigilance and get vaccinated early against seasonal influenza.

Regarding severe cases, from noon yesterday (March 7) to noon today, six additional cases of influenza-associated admission to intensive care units or death (including five deaths) among adults aged 18 or above have been recorded under the enhanced surveillance in collaboration with public and private hospitals reactivated since January 2, bringing the total to 471 (351 deaths) so far. Among them, 448 were A(H3N2), five were A(H1N1)pdm09, seven were A pending subtype and 11 were B. In the last winter season in early 2014, 266 cases (133 deaths) were filed.

Meanwhile, no additional cases of severe paediatric influenza-associated complication or death among children aged under 18 have been reported since yesterday via the ongoing reporting system, and the total this year hence remains at 17 (one death) and all were A(H3N2). In 2014, 27 cases (four deaths) were filed.

February 26, 2015

A west Indian city has banned large public gatherings in an attempt to halt the spread of swine flu, which has claimed at least 926 lives nationwide in 11 weeks.

Officials prohibited gatherings of five or more people in Ahmedabad, the capital of Gujarat state, starting Wednesday. Marriages and funerals are exempt from the ban, but participants will need to wear protective masks, officials said.

The law invoked for the ban is generally used to maintain law and order, not health, and officials said they would be flexible in interpreting which public events would be prohibited.

Gujarat has had the second-highest number of deaths, with 231, after the northwestern state of Rajasthan, where 234 have died.

Among the thousands in Gujarat testing positive for H1N1, the virus which causes swine flu, were its assembly speaker and state health minister.

Doctors said the death toll was high because many patients delayed going to hospitals.

The Health Ministry said most of the more than 16,000 cases reported nationwide since mid-December were in the states of Gujarat, Rajasthan, Maharashtra, Telangana and Madhya Pradesh.

February 24, 2015

Via CIDRAP: Flu Scan for Feb 24, 2015. Click through for the full report (which also discusses seasonal flu) and numerous links. Excerpt:

H7N9 sickens three more in China

Two of China's provinces—Anhui and Guangdong—reported a total of three new H7N9 avian influenza cases today, according to separate health department reports.

Anhui province reported two of the case-patients, a 48-year-old man from Ma'anshan and a 75-year-old man from Wuhu, according to a provincial report translated and posted by FluTrackers, an infectious disease news message board. Both are in critical condition and had been exposed to live poultry before they got sick.

The two infections are Anhui province's first H7N9 cases in the third wave of illnesses that started in October.

Guangdong province's patient is a 58-year-old man from Zhaoqing who is hospitalized in critical condition, according to FluTrackers' translation of an official provincial report.

The three new cases lift the global H7N9 total to 611, according to a case list maintained by FluTrackers.

Egypt confirms 5 new H5N1 cases

Egyptian authorities have confirmed five new cases of H5N1 avian flu, continuing an unusual flood of cases in recent weeks, according to a Ministry of Health and Population statement translated and posted today by FluTrackers.

The cases involve a 34-year-old man in Faiyum governorate, a 36-year-old man in Cairo governorate, a 38-year-old man and a 3-year-old girl from Asyut governorate, and a 27-year-old man from Minya governorate. The 34-year-old is being treated at a Faiyum hospital, while the other four patients have been treated and released, the health ministry said.

The statement said eight H5N1 patients remain hospitalized in the country. Egypt has now confirmed 69 cases this year, according to a list maintained by FluTrackers. In all of last year the country reported 30 H5N1 cases, according to World Health Organization (WHO) data. The previous high was in 2006, when Egypt had 55 WHO-confirmed cases.

A 61-year-old man remains in critical condition with H7N9 bird flu at Queen Mary Hospital, the third imported case this winter.

The Centre for Health Protection is investigating why a doctor did not immediately suspect flu, despite guidelines issued amid an outbreak in the mainland, which has seen 582 cases since March 2013.

According to the CHP, preliminary tests on the patient were positive for H7N9 and negative for H1 and H3 viruses.

The center has so far located 10 close contacts and 16 other contacts of the patient. They remained asymptomatic except for one who had mild cold symptoms before exposure to the patient.

A center spokesman said tracing of the health-care workers involved at Queen Mary Hospital is under way.

The man, with underlying illness, had suffered from a cough and shortness of breath since February 16 and consulted a private doctor on the same day.

He then attended the accident and emergency department of Queen Mary Hospital last Friday and was admitted.

His condition deteriorated and he was transferred to the intensive care unit. He was confirmed with H7N9 on Sunday.

The patient had traveled to Zhangmutou in Dongguan, Guangdong, on February 6-8 and again on February 14-15, where he visited a wet market and bought two chickens. He brought the birds back back to the city after they were cooked.

University of Hong Kong microbiologist Ho Pak-leung said the epidemic in the mainland seems to be moving south from Shanghai to Guangdong, closer to Hong Kong.

February 23, 2015

The Centre for Health Protection (CHP) of the Department of Health today (February 23) reported the latest surveillance data of the winter influenza season, and again urged the public to heighten vigilance and get vaccinated early against seasonal influenza.

Regarding severe cases, from noon yesterday (February 22) to noon today, nine additional cases of influenza-associated admission to intensive care units or death (six death cases) among adults aged 18 or above have been recorded under the enhanced surveillance in collaboration with public and private hospitals reactivated since January 2 and two additional deaths were recorded among previously reported cases, bringing the total to 352 (254 deaths) so far. Among them, 340 were A(H3N2), four were A pending subtype and eight were B. In the last winter season in early 2014, 266 (133 deaths) were filed.

Meanwhile, no additional cases of severe paediatric influenza-associated complication or death among children aged under 18 have been reported since yesterday via the ongoing reporting system and the total this year hence remains at 16 (one death). Among them, 15 were A(H3N2) and one was A pending subtype. In 2014, 27 (four deaths) were filed.

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals about active public health threats. This issue covers the period 15 to 21 February 2015 and includes updates on Ebola virus disease, seasonal Influenza, botulism in people who inject drugs, MERS-CoV

Ebola virus disease epidemic – West Africa

As of 15 February, WHO is reporting 23 253 cases of Ebola virus disease (EVD) related to the outbreak in West Africa, including 9 380 deaths. According to the weekly WHO, Ebola activity stabilised in West Africa last week with 128 newly confirmed Ebola cases reported in the three countries compared with 144 during the previous week. ECDC published a rapid risk assessment on 4 February 2015.

Seasonal influenza 2014-2015

In the past week, 15 countries reported stable and increasing influenza activity. The overall proportion of influenza positive samples and the total number of sentinel influenza virus detections decreased slightly which may be indicative of several countries having passed their peaks of influenza activity. ECDC monitors and reports on influenza activity in Europe on a weekly basis throughout the flu season.

Botulism in people who inject drugs - Norway and the UK

In the past week, two new cases of wound botulism have been reported in people who inject drugs in Oslo, Norway. Since December 2014, 25 cases of botulism have been reported in Norway (10) and Scotland (15) affecting people who inject drugs. Four additional cases are under investigation in Scotland. These cases raise the possibility that a batch of contaminated heroin is in circulation.

Middle East respiratory syndrome – coronavirus (MERS CoV)

Since the last update of 10 February 2015 and as of 19 February, Saudi Arabia has reported 35 additional cases of MERS-CoV. To date, all cases have either occurred in the Middle East, have direct links to a primary case infected in the Middle East, or have returned from this area. The source of the virus remains unknown, but the pattern of transmission and virological studies points towards dromedary camels in the Middle East being a reservoir from which humans sporadically become infected through zoonotic transmission.

Since April 2012 and as of 19 February 2015, 1 040 cases of MERS-CoV have been reported by local health authorities worldwide, including 414 deaths.

February 21, 2015

It's official. Influenza, commonly known as "the flu", has reached Denmark.

"We've been waiting for it since Christmas as it has been well underway in Western and Central Europe. Fortunately, Denmark has been spared until now," Tyra Grove Krause, a senior physician at the State Serum Institut (SSI), told Politiken.

Although the virus has been largely absent in Denmark throughout the winter, in the past three weeks, more and more people have tested positive.

More people have been affected by the virus now than at the same time last year.

Children and the elderly are at risk

Still, the current situation is far from the severe epidemics that ravaged Denmark in the winters of 2009-2010, 2010-2011 and 2012-13.

According to SSI, three weeks of continuous increase in the number of infected people means more are expected to get ill in the next few weeks.

"Especially children under age five and the elderly can be hit severely," Krause noted.

Influenza virus type A H3N2

Europe has been plagued by the influenza virus type A H3N2 that mainly targets young children and people over the age of 65.

In several European countries, the authorities have already reported increased mortality rates among the elderly as a direct result of this type of virus.

SSI has reported that it is precisely this type of influenza that people are being infected by in Denmark.

A vaccine may not help this time

Krause explained that the usual vaccine will not protect people as effectively against this type of virus, which may explain the higher mortality rates in some European countries.

She believes, however, that getting vaccinated is not a waste of time, as it would protect people against other types of influenza.

During week seven, a total of 662 patients were tested for flu, of which 24 percent were positive.

That is far from the 51 percent positively tested in the rest of Europe.